Wednesday, October 22, 2014

Ebola Outbreak Worse Than Reported

The Guardian reports that the true death toll from Ebola is under reported:
The true death toll from the Ebola epidemic is being masked by chaotic data collection and people’s reluctance to admit that their loved ones had the virus, according to one of west Africa’s most celebrated film-makers. 
Sorious Samura, who has just returned from making a documentary on the crisis in Liberia, said it is very clear on the ground that the true number of dead is far higher than the official figures being reported by the World Health Organisation. 
Liberia accounts for more than half of all the official Ebola deaths, with a total of 2,458. Overall, the number of dead across Liberia, Sierra Leone and Guinea has exceeded 4,500. 
Samura, a television journalist originally from Sierra Leone, said the Liberian authorities appeared to be deliberately downplaying the true number of cases, for fear of increasing alarm in the west African country. 
“People are dying in greater numbers than we know, according to MSF [Médecins sans Frontières] and WHO officials. Certain departments are refusing to give them the figures – because the lower it is, the more peace of mind they can give people. The truth is that it is still not under control.” 
WHO has admitted that problems with data-gathering make it hard to track the evolution of the epidemic, with the number of cases in the capital, Monrovia, going under-reported. Efforts to count freshly dug graves had been abandoned. 
Local culture is also distorting the figures. Traditional burial rites involve relatives touching the body – a practice that can spread Ebola – so the Liberian government has ruled that Ebola victims must be cremated. 
“They don’t like this burning of bodies,” said Samura, whose programme will air on 12 November on Al Jazeera English. “Before the government gets there they will have buried their loved ones and broken all the rules.” 
Kim West of MSF admitted that calculating deaths was “virtually impossible”, adding that only when retrospective surveys were conducted would the true figure be known.
More concerning for us, however, is that Ebola will likely find its way to the U.S. and other countries in the same way as HIV--through sexual transmission, brought back by sex tourists. The Guardian article goes on to note:
Samura believes sexual promiscuity among westerners could play a role in the virus’s spread abroad. Almost immediately after the outbreak was reported in March, Liberia’s health minister warned people to stop having sex because the virus was spread via bodily fluids as well as kissing.“I saw westerners in nightclubs, on beaches, guys picking up prostitutes,” he said. “Westerners who ought to know better are going to nightclubs and partying and dancing. It beggars belief.It’s scary.”
 Discussing this story, the American Interest observes:
If true, Ebola may not come to the West via Liberian or other West African citizens, but from returning aid workers, tourists, business people and others. 
One possibility: Many businessmen in West Africa are of Lebanese and Syrian extraction. Put the Ebola virus into a combat zone where medical services are already overwhelmed, and the consequences in refugee camps and cities under siege don’t bear thinking about. 
It’s much too soon to tell what the course of the Ebola epidemic will be, but so far it has to be said that Ebola has been easier to catch and harder to contain than officials everywhere have anticipated.
          Like AIDS, I think homosexuals will play a pivotal role in spreading Ebola. Why? Well, HIV is another virus that requires transmission via bodily fluids (I will assume, at this point, that Ebola has not become airborne). "The Body," a web-site describing AIDS and AIDS prevention, notes:
 HIV can enter only through an open cut or sore, or through contact with the mucous membranes in the anus and rectum, the genitals, the mouth, and the eyes. 
... Blood contains the highest concentration of the virus, followed closely by semen, followed by vaginal fluids. These are the three basic fluids that infect adults with HIV.
It notes that there are three primary ways HIV can be transmitted: (1) Unprotected sexual contact; (2) Direct blood contact, including injection drug needles, blood transfusions, accidents in health care settings or certain blood products; and (3) Mother to baby (before or during birth, or through breast milk). As to sexual contact, the three main ways that HIV is transmitted are (1) vaginal sex, (2) anal sex, and (3) oral sex. The site indicates that of the three methods, anal sex poses the greatest risk "because the membranes are thinner, tearing happens more easily, and there is no natural lubrication."

          Similar to Ebola, HIV was an animal disease that leaped to humans, most likely through the consumption of bush meat. The disease lingered for decades without any significant outbreak, until it was taken to Haiti, most likely through a guest worker. Haiti was a popular tourist stop in the 1980's, and it was from Haiti that the disease spread to the U.S., most likely through sexual transmission between tourists and sex workers--particularly homosexuals. Although AIDS is primarily a heterosexual disease in Africa, it is primarily a disease of middle-aged homosexuals and young black men in the United States. (I.e., homosexual men and their prostitutes).

          Dr. Fauci downplays the comparison between HIV and Ebola:
In West Africa right now, according to CDC statistics, for every person infected with Ebola, two close contacts acquire it. That’s a recipe for disaster there, especially when combined with fruit bats spreading the virus to other regions and other countries on the African continent. 
But here in America — where we’re able to identify symptoms rapidly and isolate sick patients, keeping others away from their secretions — any Ebola outbreak will be quickly squashed. 
The reason HIV spread wildly here is that it’s often hard to know someone has it; it can spread silently from one patient to the next via sex or sharing needles. 
As Dr. Anthony Fauci, a pioneer AIDS researcher who’s now the director of the National Institute of Allergy and Infectious Diseases, told me, “Ebola is transmitted when a person is sick, usually very sick, and you have to come into direct contact with bodily fluids. So it’s difficult not to know you’re exposed.” 
By comparison, Fauci said, though HIV is less transmissible, the impact has been far greater because of the large numbers of people involved and because “you can unwittingly get into contact with someone and have it transferred.”
However, we have recently seen reports indicating that the Ebola may be transferred more readily than thought, and it may be transferred beyond the 21-day quarantine period recommended by the CDC. In both cases, the result is that the disease may have an opportunity to spread when the person is not puking up their guts.

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